Clinical nutrition ESPEN最新文献_第8页

Association between phase angle and inflammatory blood biomarkers in community-dwelling older adults: Itabashi Longitudinal Study on Aging 社区老年人相位角与炎症性血液生物标志物之间的关系。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-26 DOI: 10.1016/j.clnesp.2024.09.017

Sho Hatanaka , Takashi Shida , Yosuke Osuka , Narumi Kojima , Keiko Motokawa , Tsuyoshi Okamura , Hirohiko Hirano , Shuichi Awata , Hiroyuki Sasai

Background & aim

Bioelectrical impedance analysis–derived phase angle (PhA) reflects the disruption of the cell membrane and intra- and extracellular fluid imbalances caused by chronic inflammation. This study examined the association between PhA and inflammatory markers in community-dwelling older adults.

Methods

A sex-stratified logistic regression analysis was conducted, with elevated C-reactive protein (CRP; ≥3.0 mg/L) and interleukin-6 (IL-6; >4.0 pg/mL) levels as the outcomes and whole-body and local PhAs as the exposures. The same analysis was conducted with further stratification for age, overweight status, history of inflammation-related non-communicable diseases, and dietary inflammatory index. The ability to identify inflammation in whole-body and local PhAs was assessed using a receiver operating characteristic (ROC) curve.

Results

This study included 1664 participants (age: 76 [73–80] years; 855 women). In men, significant odds ratios (ORs) at the 95 % confidence interval (95 % CI) were observed for abnormal CRP and IL-6 levels for both whole-body and leg PhAs in the third quartile compared with the lowest quartile (OR [95 % CI] for abnormal CRP levels: 0.36 [0.18, 0.68] for whole-body PhA, 0.51 [0.27, 0.95] for leg PhA; OR [95 % CI] for abnormal IL-6 levels: 0.36 [0.15, 0.81] for whole-body PhA, 0.33 [0.12, 0.78] for leg PhA). The areas under the ROC curves (95 % CI) for identifying abnormal IL-6 were mild in men (0.62 [0.54, 0.70] for whole-body PhA and 0.62 [0.55, 0.70] for leg PhA). In men without a history of inflammation-related non-communicable diseases, it was 0.72 (0.59, 0.85) for whole-body PhA and 0.68 (0.54, 0.81) for leg PhA. In women, the PhA was not significantly associated with inflammatory markers.

Conclusion

PhA is associated with inflammation in community-dwelling older men, but may need to be combined with other information to identify inflammation.

背景和目的：生物电阻抗分析得出的相位角（PhA）反映了慢性炎症引起的细胞膜破坏和细胞内外液体失衡。本研究探讨了社区老年人的 PhA 与炎症指标之间的关系：以C反应蛋白（CRP；≥3.0 mg/L）和白细胞介素-6（IL-6；>4.0 pg/mL）水平升高为结果，全身和局部PhAs为暴露，进行了性别分层逻辑回归分析。在进行同样的分析时，还对年龄、超重状况、炎症相关非传染性疾病史和饮食炎症指数进行了进一步分层。使用接收器操作特征曲线（ROC）评估了在全身和局部PhAs中识别炎症的能力：这项研究包括 1,664 名参与者（年龄：76 [73-80] 岁；855 名女性）。与最低四分位数相比，男性全身和腿部 PhAs 第三四分位数的 CRP 和 IL-6 水平异常的 95% 置信区间 (95% CI) 的几率比（CRP 水平异常的几率比[95% CI]：0.全身 PhA 为 36 [0.18, 0.68]，腿部 PhA 为 0.51 [0.27, 0.95]；IL-6 水平异常的 OR [95% CI]：全身 PhA 为 0.36 [0.15, 0.81]，腿部 PhA 为 0.33 [0.12, 0.78]）。男性识别异常 IL-6 的 ROC 曲线下面积（95% CI）较小（全身 PhA 为 0.62 [0.54, 0.70]，腿部 PhA 为 0.62 [0.55, 0.70]）。在没有炎症相关非传染性疾病病史的男性中，全身 PhA 为 0.72（0.59，0.85），腿部 PhA 为 0.68（0.54，0.81）。在女性中，PhA 与炎症指标没有明显关联：结论：在社区居住的老年男性中，PhA 与炎症相关，但可能需要结合其他信息来识别炎症。

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引用次数: 0

Low visceral fat volume and hypoalbuminemia as prognostic markers in hospitalized patients with coronavirus disease 2019 during the omicron variant epidemic 低内脏脂肪量和低白蛋白血症是 2019 年奥米克变种流行期间冠状病毒病住院患者的预后指标。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-26 DOI: 10.1016/j.clnesp.2024.09.016

Shin Nakayama , Yoshitaka Wakabayashi , Kyotaro Kawase , Ai Yamamoto , Takatoshi Kitazawa

Background & aims

The rate of severe cases of coronavirus disease 2019 (COVID-19) has decreased since the Omicron variant became epidemic. Visceral fat volume was a risk factor for COVID-19 severity with prior prevalent variants, but whether visceral fat volume remains a risk factor for the Omicron variant is unclear. We investigated the associations of clinical factors including visceral fat volume with severity and mortality among hospitalized patients with COVID-19 during the Omicron variant epidemic.

Methods

This was a single-center retrospective cohort study conducted at the Teikyo University Hospital in Japan. We included hospitalized patients with COVID-19 during the Omicron variant epidemic who underwent computed tomography of the abdomen. Clinical data were obtained from the medical records and visceral fat area (VFA) was measured using a 3-dimensional image analysis system volume analyzer. Severity was determined by the presence or absence of oxygen supplementation.

Results

Among the 226 patients, 66 patients showed moderate severity and 29 patients were non-survivors. Hypoalbuminemia was associated with severity (odds ratio [OR] 3.93, 95 % confidence interval [CI] 1.91–8.07; p = 0.0002), and hypoalbuminemia (OR 8.38, 95%CI 2.37–29.58; p = 0.0010) and low VFA (OR 3.40, 95%CI 1.15–10.06; p = 0.027) were associated with mortality. Decision tree analysis showed that mortality rate in the hypoalbuminemia and low-VFA group (37.3 %) was significantly higher than in other groups (p ≤ 0.01).

Conclusions

Low visceral fat volume and hypoalbuminemia were associated with mortality in hospitalized patients with COVID-19 during the Omicron variant epidemic. Classification by VFA and serum albumin may allow simple prediction of mortality risk among hospitalized patients with COVID-19.

背景与目的：自Omicron变种流行以来，冠状病毒病2019（COVID-19）重症病例的发病率有所下降。在以前流行的变异株中，内脏脂肪量是COVID-19严重程度的风险因素，但内脏脂肪量是否仍是Omicron变异株的风险因素尚不清楚。我们研究了在奥米克龙变体流行期间，包括内脏脂肪量在内的临床因素与 COVID-19 住院患者的严重程度和死亡率的关系：这是一项在日本帝京大学医院进行的单中心回顾性队列研究。我们纳入了在 Omicron 变异流行期间住院的 COVID-19 患者，他们都接受了腹部计算机断层扫描。我们从病历中获取了临床数据，并使用三维图像分析系统容积分析仪测量了内脏脂肪面积（VFA）。根据有无补氧来确定严重程度：结果：在 226 名患者中，66 名患者为中度严重，29 名患者为非幸存者。低白蛋白血症与严重程度相关（比值比 [OR] 3.93，95% 置信区间 [CI] 1.91-8.07；P = 0.0002），低白蛋白血症（OR 8.38，95%CI 2.37-29.58；P = 0.0010）和低 VFA（OR 3.40，95%CI 1.15-10.06；P = 0.027）与死亡率相关。决策树分析显示，低白蛋白血症和低内脏脂肪含量组的死亡率（37.3%）明显高于其他组别（p ≤ 0.01）：结论：低内脏脂肪量和低白蛋白血症与奥米克隆变异型流行期间 COVID-19 住院患者的死亡率有关。根据内脏脂肪量和血清白蛋白进行分类可简单预测COVID-19住院患者的死亡风险。

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引用次数: 0

Corrigendum to “Vinegar (acetic acid) intake on glucose metabolism: A narrative review” [Clin Nutr ESPEN 32 (2019) 1–7] 醋（乙酸）摄入对葡萄糖代谢的影响：叙述性综述》 [Clin Nutr ESPEN 32 (2019) 1-7] 的更正

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-24 DOI: 10.1016/j.clnesp.2024.09.013

Heitor O. Santos , Wilson M.A.M. de Moraes , Guilherme A.R. da Silva , Jonato Prestes , Brad J. Schoenfeld

引用次数: 0

BIA-assessed cellular hydration and strength in healthy older adults 通过 BIA 评估健康老年人的细胞水合作用和强度。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-19 DOI: 10.1016/j.clnesp.2024.09.010

Elena Vila , Pedro Bezerra , Bruno Silva , José Mᵃ. Cancela

Objectives

The objective of this research was to evaluate the differential relationships between various BIA-estimated compartments of body water and strength, among healthy older adults, by age range and sex.

Design

Descriptive and correlational study.

Setting and participants

A total of 234 healthy older adults (72.59 ± 7.60 years) participated in the study. Participants were recruited from community centers around Portugal and Spain. Data were recorded during May 2023. This is a physically active sample: all the participants are physically active for a minimum of three days a week.

Methods

For the study of body composition the variables extracted from the Tanita were: fat mass (FM), fat free mass (FFM), visceral fat rating (VFR), total body water (TBW), extracellular water (ECW) and intracellular water (ICW). Handgrip Strength was used to evaluate upper body strength and the Chair Stand Test for lower body strength.

Results

Differences across the various data sets were recorded in the gender variable.

When looking into the gender variable, significant correlations were recorded for the body composition variables analyzed for all age groups in the upper body strength test, except for BMI(r = .125–.878) and Fat mass (.056 to −.634). For the lower body strength test, no significant correlations were recorded for the Fat-Free mass variables (r = .164–.380), as well as for the Visceral Fat Rating(r = .082–.213) and the body water variables (TBW, ECW, ICW).

Conclusions

The hydration parameters analyzed can be related to muscle performance for Handgrip in an independent older adult population with ages ranging from 60 to 90 years.

研究目的本研究的目的是根据年龄段和性别，评估健康老年人体内不同BIA估算的体内水分与力量之间的不同关系：设计：描述性和相关性研究：共有 234 名健康老年人（72.59±7.60 岁）参加了研究。参与者从葡萄牙和西班牙的社区中心招募。数据记录于 2023 年 5 月。这是一个体力活动样本：所有参与者每周至少有三天进行体力活动：对于身体成分的研究，从 Tanita 中提取的变量包括：脂肪量（FM）、无脂肪量（FFM）、内脏脂肪率（VFR）、身体总水分（TBW）、细胞外水分（ECW）和细胞内水分（ICW）。手握力用于评估上肢力量，椅子站立测试用于评估下肢力量：各组数据在性别变量方面存在差异。在性别变量方面，除了体重指数（r=0.125-0.878）和脂肪量（0.056-0.634）外，上肢力量测试中所有年龄组的身体成分分析变量都存在显著的相关性。在下半身力量测试中，无脂肪质量变量（r= 0.164 - 0.380）、内脏脂肪评分（r= 0.082 - 0.213）和体内水分变量（TBW、ECW、ICW）均无明显相关性：结论：所分析的水合参数与年龄在 60 至 90 岁之间的独立老年人的手握肌肉性能有关。

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引用次数: 0

In vitro digestion study comparing a predigested glycerolysis product versus long-chain polyunsaturated fatty acid-rich oils (LCPUFA) as a strategy for administering LCPUFA to preterm neonates 体外消化研究：比较预消化甘油分解产物和富含长链多不饱和脂肪酸的油类 (LCPUFA)，作为向早产新生儿提供 LCPUFA 的一种策略。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-19 DOI: 10.1016/j.clnesp.2024.09.011

Assamae Chabni , Blanca Pardo de Donlebún , Celia Bañares , Carlos F. Torres

Background & aims

Maintaining an adequate supply of arachidonic acid (ARA) and docosahexaenoic acid (DHA) is essential for optimal growth of preterm infants. This study aims to evaluate and compare the digestibility and bioaccessibility of ARA and DHA oils compared to their predigested product through an in vitro digestion model.

Methods

An in vitro gastrointestinal digestion model was used in two stages: gastric digestion and intestinal digestion. Samples of two polyunsaturated rich oils (ARA and DHA oils) and their predigested product (2:1, ARA: DHA) produced by enzymatic glycerolysis have been digested for 120 min. The final digestion product obtained was composed of three phases: an upper oily phase (OP) containing the undigested species, an intermediate micellar phase (MP) containing digested and bioaccessible lipids, and a precipitate phase (PP) with insoluble compounds. The reaction was monitored by taking aliquots and their subsequent lipid extraction and analysis.

Results

Poorer digestibility for ARA and DHA oils was observed based on the percentage of the oily phase (26.7% and 20%, respectively) found compared to the glycerolysis product (GP) oily phase (13.9%). The highest micellar phase was found in the GP (approx. 83%). On the other hand, the monoglyceride (MAG) content was lower in the digestion product (DP) from ARA and DHA oils, 4.3% and 9.2%, respectively, compared to the MAG observed in the DP of GP (15%).

Conclusion

Considering the percentage of oily phase, micellar phase, and the MAG content, it can be concluded that the GP is more digestible and ARA and DHA are more bioaccessible than in its precursor oils.

背景与目的：保持花生四烯酸（ARA）和二十二碳六烯酸（DHA）的充足供应对早产儿的最佳生长至关重要。本研究旨在通过体外消化模型评估和比较 ARA 和 DHA 油与其预消化产物的消化率和生物可及性：方法：体外胃肠道消化模型分为两个阶段：胃消化和肠道消化。将两种富含多不饱和脂肪酸的油（ARA 和 DHA 油）样本及其通过酶甘油分解产生的预消化产物（2:1，ARA: DHA）消化 120 分钟。最终得到的消化产物由三相组成：上层油相（OP）含有未消化的物种，中间胶束相（MP）含有消化的和生物可获取的脂类，沉淀相（PP）含有不溶性化合物。取等分样品监测反应，然后进行脂质提取和分析：结果：与甘油分解产物（GP）油相（13.9%）相比，根据油相的百分比（分别为 26.7% 和 20%）观察到 ARA 和 DHA 油的消化率较低。GP 中的胶束相最高（约 83%）。另一方面，在 ARA 和 DHA 油的消化产物（DP）中，单甘油酯（MAG）含量较低，分别为 4.3% 和 9.2%，而在 GP 的消化产物（DP）中，单甘油酯（MAG）含量为 15%：考虑到油相、胶束相和 MAG 含量的百分比，可以得出结论：GP 比其前体油更容易消化，ARA 和 DHA 更容易被生物体吸收。

{"title":"In vitro digestion study comparing a predigested glycerolysis product versus long-chain polyunsaturated fatty acid-rich oils (LCPUFA) as a strategy for administering LCPUFA to preterm neonates","authors":"Assamae Chabni , Blanca Pardo de Donlebún , Celia Bañares , Carlos F. Torres","doi":"10.1016/j.clnesp.2024.09.011","DOIUrl":"10.1016/j.clnesp.2024.09.011","url":null,"abstract":"<div><h3>Background & aims</h3><div>Maintaining an adequate supply of arachidonic acid (ARA) and docosahexaenoic acid (DHA) is essential for optimal growth of preterm infants. This study aims to evaluate and compare the digestibility and bioaccessibility of ARA and DHA oils compared to their predigested product through an <em>in vitro</em> digestion model.</div></div><div><h3>Methods</h3><div>An <em>in vitro</em> gastrointestinal digestion model was used in two stages: gastric digestion and intestinal digestion. Samples of two polyunsaturated rich oils (ARA and DHA oils) and their predigested product (2:1, ARA: DHA) produced by enzymatic glycerolysis have been digested for 120 min. The final digestion product obtained was composed of three phases: an upper oily phase (OP) containing the undigested species, an intermediate micellar phase (MP) containing digested and bioaccessible lipids, and a precipitate phase (PP) with insoluble compounds. The reaction was monitored by taking aliquots and their subsequent lipid extraction and analysis.</div></div><div><h3>Results</h3><div>Poorer digestibility for ARA and DHA oils was observed based on the percentage of the oily phase (26.7% and 20%, respectively) found compared to the glycerolysis product (GP) oily phase (13.9%). The highest micellar phase was found in the GP (approx. 83%). On the other hand, the monoglyceride (MAG) content was lower in the digestion product (DP) from ARA and DHA oils, 4.3% and 9.2%, respectively, compared to the MAG observed in the DP of GP (15%).</div></div><div><h3>Conclusion</h3><div>Considering the percentage of oily phase, micellar phase, and the MAG content, it can be concluded that the GP is more digestible and ARA and DHA are more bioaccessible than in its precursor oils.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 75-83"},"PeriodicalIF":2.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Commentary on: “An L-shaped relationship between dietary vitamin K and atherosclerotic cardiovascular disease” 评论"膳食维生素 K 与动脉粥样硬化性心血管疾病之间的 L 型关系 "的评论。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-18 DOI: 10.1016/j.clnesp.2024.09.012

Jinxiang Peng, Haozhu Chen

引用次数: 0

Multi-chamber parenteral nutrition (PN) bags are safe and cost-effective in replacing compounded PN regimens in hospitalised patients 多腔肠外营养袋在取代住院病人的复方肠外营养方案方面既安全又经济高效

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-18 DOI: 10.1016/j.clnesp.2024.09.009

Maja Kopczynska , Simon Harrison , Kirstine Farrer , Gavin Leahy , Charlotte Ollerenshaw-Ward , Simon Lal

Background & aims

There is varied international practice in the use of ready-made multi-chamber bags (MCBs) and compounded parenteral nutrition (PN). Recent national aseptic pharmacy capacity limitations have restricted compounded PN production so we aimed to explore outcomes associated with the increased use of MCB vs compounded regimens during a period of change in PN supplies.

Methods

This was a point prevalence study conducted over two time periods, Period 1: 01.01.2022–31.03.2022 and Period 2: 01.10.2022–31.12.2022. Data were collected on PN regimen, outcomes, cost and aseptic time required to prepare PN bags.

Results

263 patients were included: 132 in Period 1 and 131 in Period 2. Overall, 2263 PN bags were utilised; 1179 in Period 1 and 1084 in Period 2. In Period 1, of all utilised bags, 138 (11.7%) were compounded PN, 356 (30.2%) supplemented MCBs and 685 (58.1%) manipulated MCBs whereas in Period 2, 0 were compounded PN, 546 (50.3%) supplemented MCBs and 538 (49.6%) manipulated MCBs. There were no significant differences in the proportion of patients with deranged blood tests between the study periods. In both periods there were only two episodes of catheter-related blood stream infection. The total cost saved in Period 2 compared to Period 1 was £20,684 and total aseptic staff time saved was 191 h.

Conclusion

Wider use of in-hospital MCB PN regimens could lead to a reduction in the need for compounded PN produced by aseptic pharmacy facilities, saving costs while maintaining good patient outcomes.

背景& 目的国际上使用现成的多室袋（MCB）和复方肠外营养液（PN）的做法各不相同。最近，由于国家无菌药房的能力有限，限制了复方 PN 的生产，因此我们旨在探讨在 PN 供应发生变化期间，增加使用 MCB 与复方方案的相关结果。收集的数据包括 PN 方案、结果、成本和准备 PN 袋所需的无菌时间：第一阶段和第二阶段分别纳入 132 名和 131 名患者。总共使用了 2263 个 PN 袋，其中 1179 个在第一阶段，1084 个在第二阶段。在第一期使用的所有药袋中，138 个（11.7%）为复方 PN，356 个（30.2%）为补充 MCB，685 个（58.1%）为人工 MCB；而在第二期使用的所有药袋中，0 个为复方 PN，546 个（50.3%）为补充 MCB，538 个（49.6%）为人工 MCB。在研究期间，血液化验出现异常的患者比例没有明显差异。在两个研究期间，只有两例导管相关血流感染。结论更广泛地使用院内 MCB PN 方案可减少对无菌药房设施生产的复方 PN 的需求，在节约成本的同时保持良好的患者预后。

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引用次数: 0

Association between salt sensitivity of blood pressure and dietary habits in survey population: A case-control study 调查人群的血压盐敏感性与饮食习惯之间的关系：病例对照研究。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-18 DOI: 10.1016/j.clnesp.2024.09.008

Ji-hong Hu , Shu-xia Wang , Yun Wang , Liangjia Cao , Keye Ru , Wenjuan Xu , Li Wang , Jiaxuan Zhang

Background

Salt sensitivity of blood pressure (SSBP) is an independent risk factor for cardiovascular diseases (CVDs) and links dietary salt with blood pressure. However, the study on the relationship between SSBP and dietary habits is rare. This study investigated the relationship between diet and SSBP in different blood pressure statues.

Methods

1459 subjects were assigned into four groups based on a case (hypertension)-control (normotension) study of SSBP and hypertension: 561 Salt-sensitive hypertension (SSH) and 235 non-salt-sensitive hypertension (NSSH) and 424 salt-sensitive normotension (SSN) and 239 non-salt-sensitive normotension (NSSN). Foods information of weekly or daily intakes were recalled. SSBP was tested with the modified salt stress test and was diagnosed with the Sullivan criteria.

Results

Compared with the NSSH and SSN groups, SSH group have lower intake of fresh fruits (both P < 0.05). Furthermore, NSSN group have the lowest intake of red meat, and bacon (P < 0.05). SSH group have the lowest intake of fresh vegetables (P < 0.05). SSN group have the highest intake of eggs, dairy products, white meat (all P < 0.05). In hypertensive patients, staple food (OR = 0.37, 95%CI: 0.10–0.64) was associated with decreased risk of salt sensitivity. In normotensive subjects, white meat (OR = 0.28, 95%CI: 0.14–0.43) was associated with reduced risk of salt sensitivity, bacon (OR = 5.39, 95%CI: 2.11–8.67) and dairy products (OR = 4.22, 95%CI: 1.82–6.56) and red meat (OR = 2.95, 95%CI: 1.15–4.84) were associated with elevated risk of salt sensitivity.

Conclusions

Dietary habits play an important role in SSBP and the role varies with blood pressure especially among population.

背景：血压的盐敏感性（SSBP）是心血管疾病（CVDs）的一个独立危险因素，它将膳食中的盐与血压联系在一起。然而，有关 SSBP 与饮食习惯之间关系的研究却很少见。方法：根据 SSBP 和高血压的病例（高血压）-对照（正常血压）研究，将 1,459 名受试者分为四组：561 名盐敏感性高血压（SSH）和 235 名非盐敏感性高血压（NSSH），424 名盐敏感性正常血压（SSN）和 239 名非盐敏感性正常血压（NSSN）。他们回忆了每周或每天摄入的食物信息。用改良盐应激试验检测 SSBP，并根据沙利文标准进行诊断：结果：与 NSSH 组和 SSN 组相比，SSH 组的新鲜水果摄入量较低（均为 PConclusions）：饮食习惯对 SSBP 起着重要作用，而且这种作用随血压的变化而变化，特别是在不同人群中。

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引用次数: 0

Association of uric acid with body adiposity and biochemical parameters in kidney transplant patients 肾移植患者尿酸与身体脂肪和生化指标的关系

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-12 DOI: 10.1016/j.clnesp.2024.09.007

Thamiris S. Vieira, Larissa S. Limirio, Erick P. de Oliveira

Background

Obesity and various biochemical parameters, including triglycerides, cholesterol, glucose, C-reactive protein, and estimated glomerular filtration rate, have been linked to elevated uric acid (UA) levels in populations with normal kidney function due to decreased UA excretion and/or increased UA synthesis. However, it remains unclear whether all these factors exhibit similar associations with UA levels in clinical populations characterized by compromised renal function, such as kidney transplant patients (KTPs).

Objective

To evaluate whether serum UA levels are associated with body adiposity and biochemical parameters in KTPs.

Methods

A cross-sectional study involving 113 KTPs was conducted. Body fat was estimated using bioelectrical impedance, and waist circumference was measured using an inelastic tape. Serum levels of UA, creatinine, glucose, triglycerides, total cholesterol, and its fractions were measured using the colorimetric method. C-reactive protein levels were assessed using the immunoturbidimetric method, and urea levels were determined via enzymatic kinetics. Glomerular filtration rate was estimated using the chronic kidney disease epidemiology collaboration equation. Linear regression analyses were employed to assess the association between serum UA levels and body adiposity as well as biochemical parameters, while adjusting for confounders.

Results

Serum UA levels exhibited a positive association with creatinine (β = 0.402; p = 0.013) and urea (β = 0.024; p = 0.001), while demonstrating an inverse association with estimated glomerular filtration rate (β = −0.030; p < 0.001). However, serum UA levels were not significantly associated with fat mass (both in kilograms and as a percentage), waist circumference, triglycerides, C-reactive protein, glucose, HDL cholesterol, LDL cholesterol, VLDL cholesterol, or total cholesterol.

Conclusion

Serum UA levels are only associated with biochemical parameters linked to renal function in KTPs. Consequently, in individuals with suboptimal renal function, such as KTPs, UA does not exhibit associations with other biochemical parameters and body adiposity, as commonly observed in non-renal disease populations.

背景：在肾功能正常的人群中，肥胖和各种生化指标（包括甘油三酯、胆固醇、葡萄糖、C 反应蛋白和肾小球滤过率）与尿酸（UA）水平升高有关，原因是尿酸排泄减少和/或尿酸合成增加。然而，在肾功能受损的临床人群中，如肾移植患者（KTPs），所有这些因素是否与尿酸水平有类似的关联仍不清楚：评估肾移植患者的血清尿酸水平是否与身体脂肪含量和生化指标相关：方法：对113名肾移植患者进行横断面研究。使用生物电阻抗估算体脂，并使用无弹性胶带测量腰围。使用比色法测量血清中的尿酸、肌酐、葡萄糖、甘油三酯、总胆固醇及其组分。C 反应蛋白水平采用免疫比浊法评估，尿素水平通过酶动力学测定。肾小球滤过率采用慢性肾脏病流行病学协作方程进行估算。采用线性回归分析评估血清尿酸水平与身体脂肪以及生化参数之间的关系，同时对混杂因素进行调整：血清尿酸水平与肌酐（β = 0.402; p = 0.013）和尿素（β = 0.024; p = 0.001）呈正相关，而与肾小球滤过率（β = -0.030; p < 0.001）呈负相关。然而，血清尿酸水平与脂肪量（千克和百分比）、腰围、甘油三酯、C 反应蛋白、血糖、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、超低密度脂蛋白胆固醇或总胆固醇没有明显关联：结论：血清尿酸水平仅与肾功能相关的生化指标有关。因此，在肾功能欠佳的人群（如 KTPs）中，尿酸与其他生化指标和身体肥胖并不相关，这在非肾脏疾病人群中很常见。

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引用次数: 0

Concurrent and predictive validity of the Global Leadership Initiative on Malnutrition criteria for adult patients in convalescent rehabilitation wards 全球领导力营养不良倡议标准对疗养康复病房成年患者的并发和预测有效性

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN

Pub Date : 2024-09-11 DOI: 10.1016/j.clnesp.2024.09.005

Shinta Nishioka , Marina Kawano , Emi Nishioka , Amika Okazaki , Manato Takagi , Tatsuya Matsushita , Yuka Tanaka , Yutaka Taketani , Shinya Onizuka

Background & aims

The Global Leadership Initiative on Malnutrition (GLIM) criteria has been recognised as major diagnostic criteria for malnutrition in adults worldwide; however, its validity in rehabilitation settings remains unclear. This study investigated the concurrent and predictive validity of the GLIM criteria for adult patients in convalescent rehabilitation wards.

Methods

This retrospective cohort study was conducted using pre-established datasets from convalescent rehabilitation wards in a hospital. The inclusion criteria were adults aged ≥18 years admitted to the wards between November 2018 and October 2020 who were available for body composition assessment. Malnutrition diagnoses were determined by registered dietitians (RDs) using the GLIM criteria. The Subjective Global Assessment (SGA) was performed by another RD and used for the malnutrition reference standard. The GLIM criteria sensitivity and specificity were examined for SGA. The odds ratios and hazard ratios of GLIM-defined malnutrition for the total score of the Functional Independence Measure (tFIM) effectiveness and non-home discharge were calculated using univariable and multivariable logistic regression analyses and Cox proportional hazard models.

Results

Data from 723 patients were extracted from the dataset. GLIM-defined malnutrition was confirmed in 207 (28.6%) patients, 87 (12.0%) with moderate malnutrition and 120 (16.6%) with severe malnutrition. The SGA graded 146 (20.2%) patients with moderate malnutrition (grade B) and 86 (11.9%) with severe malnutrition (grade C). The GLIM criteria (malnutrition/no malnutrition) had fair sensitivity (76.7%, 95% confidence interval [CI]: 70.7–82.0%) and good specificity (94.1%, 95% CI: 91.6–96.0%), indicating acceptable concurrent validity. GLIM-defined moderate malnutrition had poorer sensitivity than severe malnutrition (42.5% vs 81.4%). Logistic regression analyses revealed no evidence for the association between GLIM-defined malnutrition and poor tFIM effectiveness (adjusted odds ratio [AOR]: 1.09, 95% CI: 0.71–1.69) and non-home discharge (AOR: 1.19, 95% CI: 0.76–1.84). The Cox proportional hazard analyses also showed no effect of malnutrition on outcomes.

Conclusion

The GLIM criteria had fair sensitivity and good specificity, indicating acceptable criteria for diagnosing malnutrition in rehabilitation settings. However, its predictive validity for functional recovery and discharge outcomes was insufficient.

背景& 目的全球营养不良领导倡议（GLIM）标准已被公认为全球成人营养不良的主要诊断标准，但其在康复环境中的有效性仍不明确。本研究调查了 GLIM 标准对疗养康复病房成人患者的并发和预测有效性。方法本回顾性队列研究使用一家医院疗养康复病房预先建立的数据集。纳入标准为2018年11月至2020年10月期间入住病房、年龄≥18岁、可进行身体成分评估的成年人。营养不良诊断由注册营养师（RD）根据 GLIM 标准确定。主观全面评估（SGA）由另一名注册营养师进行，并用作营养不良参考标准。GLIM 标准对 SGA 的敏感性和特异性进行了检查。使用单变量和多变量逻辑回归分析以及 Cox 比例危险模型计算了 GLIM 定义的营养不良与功能独立性测量（tFIM）总分有效性和非居家出院的几率比和危险比。207例（28.6%）患者被证实患有GLIM定义的营养不良，其中87例（12.0%）为中度营养不良，120例（16.6%）为重度营养不良。根据 SGA 分级，146 名（20.2%）患者为中度营养不良（B 级），86 名（11.9%）患者为重度营养不良（C 级）。GLIM 标准（营养不良/无营养不良）的灵敏度尚可（76.7%，95% 置信区间 [CI]：70.7-82.0%），特异性良好（94.1%，95% 置信区间 [CI]：91.6-96.0%），表明其并发有效性可以接受。GLIM定义的中度营养不良比重度营养不良的灵敏度低（42.5% vs 81.4%）。逻辑回归分析显示，没有证据表明 GLIM 定义的营养不良与 tFIM 效果不佳（调整赔率 [AOR]：1.09，95% CI：0.71-1.69）和非居家出院（AOR：1.19，95% CI：0.76-1.84）之间存在关联。结论 GLIM 标准具有相当的灵敏度和良好的特异性，是康复环境中可接受的营养不良诊断标准。但是，其对功能恢复和出院结果的预测有效性不足。

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